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July IVF – CD1

I got my period yesterday, only three days clear of my course of ralovera. I’m very happy about that. I hate listening to people who go on about how if you relax things will “happen”, but I was very relaxed about this process and it did end up happening a lot easier for me this time. Already this round of IVF is off to a much better start and I’m trying very hard to stay positive and hopeful.

Unfortunately I couldn’t count yesterday as day one of my cycle because my blood didn’t turn red until after midday and that’s the way most fertility specialists determine when your period actually begins. If you’re like me and start off with older brown or black bleeding you need to keep that in mind. If the flow turns red at 11.59am you’re on CD1, if the flow turns red at 12.01pm, you won’t be on CD1 until the next day.

I phoned yesterday afternoon and had a chat to the head nurse at the clinic, Flo (I know…an unfortunate name for someone who works at a fertility clinic…). She asked when I’d like to come and pick up my medication pack and I told her it would need to be as early as possible so I wouldn’t be late for work.

“Well I’ll be here from 6am.” she said. “Shall I book you in at 6?”

“Um, no.” I replied. “I was thinking more along the lines of 7.30…”

She seemed to think that was funny, but agreed to book me in at that time. I was excited but not anxious to begin my cycle. I felt prepared and calm. Ready, but patient.

Apparently I was only feeling these things inwardly though, because last night while I was getting ready for bed Doug put a pillow over his head to block me out and said he couldn’t wait for my period to end so I would stop shrieking at him like a banshee. I had no idea I’d even been in a bad mood! Sometimes I think he exaggerates though. Or at least I hope he does.

This morning when I woke up I was feeling a bit jittery, but otherwise fine. I took a moment to consider the fact I am finally back on day 1 of my cycle. I rarely get to see CD1s, given I don’t ovulate and don’t regularly get periods. My last cycle ended up being 84 days. Who knows how long it would have gone on for if I hadn’t medically intervened with the ralovera.

I arrived at the hospital at about ten minutes past seven this morning, worried that I wouldn’t be able to find a parking spot. The private hospital where the clinic is located has a very tiny carpark (although they’re currently building a new multistorey parking garage because the hospital has recently expanded in size), and I was only slightly shocked to see it was already full. Luckily, I found a spot on the street pretty easily. As I was getting out of the car I dropped my car keys into a giant puddle of water and fumbled around trying to pick them up. That was the only real indication I’d given that my nerves weren’t as steely as they normally are.

At the clinic I was taken into a meeting room and Flo sat down with me to explain the protocol we’re using for this cycle. It’s another antagonist protocol without down regulation, but this time I’m using Puregon instead of Gonal-F as my follicle stimulating hormone. I’ll still be using Orgalutran as my antagonist injectable.The plan is to trigger me with Ovidrel at this stage, but Doctor B is going to be extremely cautious to avoid OHSS and if it looks like I have more than 20 follicles growing the cycle will be cancelled. If I show signs of developing OHSS again but I have less than 20 follicles growing Doctor B will likely move me to a nasal spray trigger instead of the Ovidrel and then do a “freeze-all” if we get any embryos. And if we get a good embie and we’re actually ready to go to transfer (fingers crossed we get that far this time!) I’ll be put back onto my favourite gel in the whole wide world Crinone.

I’ve never used Puregon before. It doesn’t come in an easy to use ready assembled epi-pen like the Gonal-F does. You need to insert the hormone, trigger load it and then mark on the outside with a sharpie where you’re up to on the vial. In that way it’s certainly not fool proof like Gonal-F. The trigger to inject the dose isn’t as simple as the Gonal-F epi-pen either. It’s a twist button instead of a push button. I think it will be almost impossible to do one handed on the days when Doug is away on business (factoring in I’ll need to be pinching my belly with one hand and injecting with the other). I was actually a little perplexed as to why I’ve been moved onto the Puregon at all.

“Don’t worry,” Flo said, “It’s exactly the same as Gonal-F. They stimulate in exactly the same way, they just have different names.”

“Right…” I said slowly. “Then why am I on it? Can’t I be on the Gonal-F?”

“No. The doctor has put you onto Puregon.”

“Ok.” I frowned, becoming a bit annoyined. “But why am I on the Puregon?”

“I don’t know.” Flo shrugged. “The doctor just likes to rotate her patients between the two drugs. Maybe next time you’ll get Gonal-F again.”

Then we discussed the amount of FSH I’ll be injecting each day. During my last round of IVF my previous doctor started me on 100iu, moved me up to 125iu for four days, then up to 150iu for five days. Doctor B is firmly against step up regimes and doesn’t believe they work. While I’m under her care, the dose I start on is the dose I end on. If my follicles aren’t growing I won’t be given a higher dose, I’ll simply end the cycle and start again next time with a higher dose. Apparently it’s safer that way and there’s no evidence that proves step up regimes actually improve egg growth or quality. Doctor B had it down on my schedule to inject 75iu of Puregon per day. An ultra-conservative figure to try and avoid OHSS, but one we had actually decided against at our last appointment together. I explained to Flo that it was my understanding I would be stimming with 100iu per day and she happily crossed out 75 and wrote 100 on my schedule without an argument.

Flo did say it’s important to Doctor B that I inject with Puregon in the morning, and then once I get to day 6 and I start my Orgalutran shots I need to do them in the evening to allow at least 12 hours gap between them. This is completely different to the advice given by my last clinic. I took both shots at the same time during my last round of IVF, and merely alternated sides of my tummy each night when I took them. I ended up with 34 eggs at pick up so I’d like to see how splitting the injections will make a difference.

After Flo was happy I’d received all the necessary information my medications, a sharps container, and instructional leaflets were packed up into a cooler bag with an ice brick and handed to me at the front desk. I found it a bit ironic that the cooler bag my medications were in was the exact same style used by my previous clinic. It sort of makes me wonder if every clinic gives their patients fertility drugs in this same cooler bag, and if you’re seen carrying one it’s like a secret signal to other women going through treatment that you’re part of the IVF sisterhood. This inconscpicious green cooler bag really screams I’m part of the club!

After my appointment I raced off to work and hid the cooler bag Flo had given me in the back of the staff fridge.

Now there’s nothing to do but wait until my first injection tomorrow morning. Hopefully Puregon is painless like the Gonal-F injections and not excrutiating like Orgalutran. I emailed Doug to let him know I didn’t feel like it’s real that the wait is finally over, and his response was “well it’s very real to me!”

I’m sure it’ll feel real tomorrow when I’m getting stuck with a needle!! My poor ovaries, they don’t have any idea what’s about it hit them…..

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2 thoughts on “July IVF – CD1”

Why would they cancel you if you had more than 20 follicles??? I developed 35 and they triggered me with lupron to help with the OHSS. I did not develop OHSS. You could freeze all embryos and do a FET. Seems kinda strange to me

It seems to be standard practice in Australia to cancel a cycle if more than 20 follicles are large. I think the real issue is that if you get OHSS badly once you’re more likely to get it again. I had 34 picked up last cycle and my eggs were all really poor quality so I think they’re going to be extremely conservative this cycle to try and keep my follicle numbers down and keep me out of hospital. I completely agree with you that I should be triggered with lupron and still have a pick up though. It’ll be so frustrating to get that far then have the cycle cancelled.